Saturday, December 04, 2004

Oncall again


Oncall again. Tired beyond belief. It has been a busy night... all the teams are getting crazy admissions. We've already had a number of unstable patients. And already one code today. Thankfully that guy came out ok. My hunch proved right; hypoglycemic seizure.Have another 14 hours before I complete my 30-hour run. And my migraine is acting up...
These are my dreaded pagers. The one on the left is the code pager. I remember the pride I felt when I first picked my pager up.
"Wow, I'm a real doctor now."
An hour into my first call, after it had beeped over 20 times, I was ready to flush it down the toilet. So much for pride.
If I could give advice to would-be medical students, it would be to read Samuel Shem's 'The House of God'. It's almost required reading amongst interns and residents, mainly because it captured the plight, trials and tribulations this group of new doctors had to endure. It was based loosely on the hospital of the Harvard Medical School. While in some parts exaggerated, a lot of the emotions and insecurities were real. People who have idealistic, unreal impressions of the glories of being a doctor need to realize what may be in store. And a lot of the cynicism in the book (and in real life amongst docs). After having been a doctors for 3 years, I realize the laws quoted in the book were often true.

LAWS OF THE HOUSE OF GOD
I. GOMERS* DON'T DIE.
II. GOMERS GO TO GROUND.
III. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
IV. THE PATIENT IS THE ONE WITH THE DISEASE.
V. PLACEMENT COMES FIRST.
VI. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.
VII. AGE + BUN = LASIX DOSE.
VIII.THEY CAN ALWAYS HURT YOU MORE.
IX. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
X. IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER.
XI. SHOW ME A MEDICAL STUDENT WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
XII. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
XIII.THE DELIVERY OF MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

*Refers to an elderly patient by the author in the book. Not really a politically correct term; unfortunately, used frequently in real life.

From House of God by Samuel Shem

2 Comments:

Anonymous Anonymous said...

Hi I hope you don't mind me asking you a couple questions. See, I am a paramedic in the U.S..but currently living in UK. My 22 y.o brother came to see my parents over Christmas (Ireland)and c/o Chest Pressure.. He was in rapid a-fib rate 180-200. The hosp didnt cardiovert him...decided to just put him on asprin and see if he converts to NSR on his own....they did an echocardiogram...he has Right ventrical only has EF of 40%. Structuraly everything looks good. After he didnt convert on his own they put him on 10mg coumadine loading dose for 5 days. His INR today is 1.6 so they decreased his dose to 5mg/day. he is also on beta blocker to control his rate. My question is ..Do u think it is at all possible to have an EF of 40% due to AFib? When he is cardioverted do you think it will get better? Are there any studies of EF that are poor due to A-fib? Our Dad has massive cariac problems..3 MI's etc..but he is 79 and it started in his mid 50's. They believe the Afib came on from drinking red bull and vodka. His vitals are wnl..as for now he wont fly back to Boston, because if he sits upright for too long he feel like his heart is racing...I hope you don't mind..but I was looking online and saw your journal.If you could just give me your thoughts I would really appreciate it! cellasky@earthlink.net

3:34 PM  
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